Monday, November 16, 2009

Bill Maher on Vaccination

Bill Maher has attempted to clarify his position on vaccination [Vaccination: A Conversation Worth Having]. His blog is a lot like his TV show. It's a confusing, rambling, attempt at justifying an indefensible position using (attempted) humor, sarcasm and anecdote as a substitute for rationalism.

The question is whether vaccinations are good or bad. It's a strictly scientific question with a well-known scientific answer.

As far as I can tell, these are Bill Maher's main reasons for opposing vaccinations.

You wouldn't need to have vaccinations if you had a healthy immune system to begin with. (And I'm sure he has some opinions on what you should eat to ensure a healthy immune system.)

The success of vaccinations has been exaggerated by the medical community but he's not accusing anyone of a conspiracy.

Vaccines have bad things in them and they may be harmful to healthy people.

Vaccinations are supported by drug companies and you need to be skeptical about anything that's supported by large for-profit corporations.

I'm just trying to represent an under-reported medical point of view in this country, I'm not telling a specific pregnant lady what to do. With unlimited air time, I would have, for example, added to my discussion with Dr. Bill Frist on October 2 that, yes, any flu or health challenge can be dangerous when you're pregnant, and if your immune system is already compromised by, for example, eating a typical American diet, then a flu shot can make sense. But someone needs to be representing the point of view that says the preferred way to handle flus is to have a strong immune system to begin with, and getting lots of vaccines might not be the best way to accomplish that over the long haul.

Now, sometimes its OK to fuck with nature -- I believe "intelligent design" is often anything but intelligent; that "God's perfect universe" is actually full of fuck ups and design flaws, like cleft lips and Down Syndrome -- so correcting nature is sometimes the right thing to do. And then, sometimes its not. For me, the flu shot is in the "not" category.

In addition, my audience is bright, they wouldn't refuse a flu shot because they heard me talk about it, but if they looked into the subject a little more, how is that a bad thing? If they went to the CDC Web site and saw what's in the vaccine -- the formaldehyde, the insect repellent, the mercury -- shouldn't they at least get to have the information for themselves?

Instead of setting up this straw man of me not understanding germs or viruses, let's have a real debate about how much we should use vaccines and antibiotics. Of course it's good that we have them in our arsenal, but isn't the real skeptic the one who asks if these powerful but toxic methods do harm to what actually is a a very good defensive system, the one you were born with?

Also, I have never said there was a medical conspiracy. In fact, when Howard Dean asked me that, my response was "I wouldn't call it a conspiracy." Any more than there's a conspiracy for the Pentagon budget to be obscenely bloated and operated largely for the corporate welfare of defense contractors. If these are conspiracies, they're mostly legal ones that happen in plain sight. (Good time here to plug the hostess' book, Pigs At the Trough, it's all in there!) I have, in fact, used the phrase "medical-pharmaceutical-food industry" complex in comparing it to Eisenhower's famous depiction of a "military-industrial complex."

I believe in science and I believe in studies to determine the truth. I also believe Senator Ron Wyden of Oregon was correct when he said recently on MSNBC: "If you've got a checkbook in this town, you can get just about any set of facts you want." So if I remind you of a conspiracy theorist, you sometimes remind me of Britney Spears when she said "we should just do whatever the president says to do, and not ask questions and just support him." The medical community can be brutal on dissent, which would hold more weight if I thought this was a terribly healthy country, which it isn't. Health care is one sixth of our economy, and we spend way more on it than any other nation. The elephant in the room of the health care debate is that we are going to have a high health care bill every year no matter what law they pass because we're sick -- we need a lot of drugs and services.

Am I a conspiracy theorist if I suggest that since the network's nightly news broadcasts are sponsored almost entirely by prescription drug ads, that you might have to hold your breath a long time before you hear the alternative point of view to using pharmaceuticals to cure all our ailments?

Is it conspiracy theory to believe that American medicine too much treats symptoms and not root causes of disease? I always ask my friends when they go to the doctor for something, "Did your doctor ask you what you eat?" The answer is almost always 'no,' and a lot can be cured with diet and a healthier lifestyle. (And a lot can't. I also understand the role of genetics and generations of artificial selection). But Americans don't want to hear that, so doctors don't push it. It's easier and more profitable to write a prescription for Lipitor. They're not bad people, and at the end of the day, you can't make someone eat right. I like and respect all the M.D.s I've had over the years, and for the record, I have a naturopath doctor and I have a Western doctor. I would make an analogy to Republicans and Democrats: in both politics and health, I don't commit to either party because I'm on the side of the truth, whoever has it. In both cases, I'm an Independent.

This last quotation is the most revealing of all. Bill Maher listens to his naturopath doctor and feels competent to distinguish the truth when his quack doctor disagrees with evidence-based medicine (e.g. "Western" medicine).

In addition to falling for quackery, Bill Maher is making an elementary error in logic. Yes, it's true there are problems with modern medicine and the influence of drug companies, especially in the USA. But that's not to be confused with a rational discussion about the value of vaccinations. The scientific judgment about whether vaccinations are good or bad is independent of any opinions you might have about conspiracies, imagined or otherwise. The real question isn't about drug companies, it's whether you accept science or quackery.

The scientific evaluation of vaccination takes place in many countries throughout the world, including those with socialized medicine. They have all concluded that vaccinations are a proven technology that prevents disease.

Maher's first point is actually well-taken. Prevention should definitely be stressed more and a healthy immune system can fight infections better and reduce the probability of getting them.

Let's think about that for a second.

Imagine that you are a well-to-do parent living in a Western industrialized nation. You and your spouse are healthy adults and you are able to provide everything necessary so your children can be as healthy as possible.

Would you get them immunized against measles, mumps, and diphtheria?

If the answer is "no," then you are stupid and you are a menace to your children and other people's children.

If the answer is "yes," then your argument, and Bill Maher's, is irrelevant: being healthy is not a substitute for immunization.

I take Anonymous' comment to be in the vein of "healthy populations are less susceptible to infections"; ie it's a good idea but distinct. If you are vaccinated doesn't mean you won't weaken your resistance by bad diet, just as having a good diet doesn't mean you can forgo vaccination.

Being healthy is not a substitute for immunization; when did I say that? The real point I was making is that prevention is often not stressed as much as cures when it should be, especially by the media.

Unfortunately, this discussion is centered too much on the indidviduum. Thereby oe misses important aspects of vaccination campains which are rather to protect a population than a single human being by interupting the infection chain. Vaccinating the healthy population will also protect the weak like immunocompromised patients, newborns etc.

Laurence A. Moran

Larry Moran is a Professor in the Department of Biochemistry at the University of Toronto. You can contact him by looking up his email address on the University of Toronto website.

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The Sandwalk is the path behind the home of Charles Darwin where he used to walk every day, thinking about science. You can see the path in the woods in the upper left-hand corner of this image.

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Some readers of this blog may be under the impression that my personal opinions represent the official position of Canada, the Province of Ontario, the City of Toronto, the University of Toronto, the Faculty of Medicine, or the Department of Biochemistry. All of these institutions, plus every single one of my colleagues, students, friends, and relatives, want you to know that I do not speak for them. You should also know that they don't speak for me.

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Quotations

The old argument of design in nature, as given by Paley, which formerly seemed to me to be so conclusive, fails, now that the law of natural selection has been discovered. We can no longer argue that, for instance, the beautiful hinge of a bivalve shell must have been made by an intelligent being, like the hinge of a door by man. There seems to be no more design in the variability of organic beings and in the action of natural selection, than in the course which the wind blows.Charles Darwin (c1880)Although I am fully convinced of the truth of the views given in this volume, I by no means expect to convince experienced naturalists whose minds are stocked with a multitude of facts all viewed, during a long course of years, from a point of view directly opposite to mine. It is so easy to hide our ignorance under such expressions as "plan of creation," "unity of design," etc., and to think that we give an explanation when we only restate a fact. Any one whose disposition leads him to attach more weight to unexplained difficulties than to the explanation of a certain number of facts will certainly reject the theory.

Charles Darwin (1859)Science reveals where religion conceals. Where religion purports to explain, it actually resorts to tautology. To assert that "God did it" is no more than an admission of ignorance dressed deceitfully as an explanation...

Quotations

The world is not inhabited exclusively by fools, and when a subject arouses intense interest, as this one has, something other than semantics is usually at stake.
Stephen Jay Gould (1982)
I have championed contingency, and will continue to do so, because its large realm and legitimate claims have been so poorly attended by evolutionary scientists who cannot discern the beat of this different drummer while their brains and ears remain tuned to only the sounds of general theory.
Stephen Jay Gould (2002) p.1339
The essence of Darwinism lies in its claim that natural selection creates the fit. Variation is ubiquitous and random in direction. It supplies raw material only. Natural selection directs the course of evolutionary change.
Stephen Jay Gould (1977)
Rudyard Kipling asked how the leopard got its spots, the rhino its wrinkled skin. He called his answers "just-so stories." When evolutionists try to explain form and behavior, they also tell just-so stories—and the agent is natural selection. Virtuosity in invention replaces testability as the criterion for acceptance.
Stephen Jay Gould (1980)
Since 'change of gene frequencies in populations' is the 'official' definition of evolution, randomness has transgressed Darwin's border and asserted itself as an agent of evolutionary change.
Stephen Jay Gould (1983) p.335
The first commandment for all versions of NOMA might be summarized by stating: "Thou shalt not mix the magisteria by claiming that God directly ordains important events in the history of nature by special interference knowable only through revelation and not accessible to science." In common parlance, we refer to such special interference as "miracle"—operationally defined as a unique and temporary suspension of natural law to reorder the facts of nature by divine fiat.
Stephen Jay Gould (1999) p.84

Quotations

My own view is that conclusions about the evolution of human behavior should be based on research at least as rigorous as that used in studying nonhuman animals. And if you read the animal behavior journals, you'll see that this requirement sets the bar pretty high, so that many assertions about evolutionary psychology sink without a trace.

Jerry Coyne
Why Evolution Is TrueI once made the remark that two things disappeared in 1990: one was communism, the other was biochemistry and that only one of them should be allowed to come back.

Sydney Brenner
TIBS Dec. 2000
It is naïve to think that if a species' environment changes the species must adapt or else become extinct.... Just as a changed environment need not set in motion selection for new adaptations, new adaptations may evolve in an unchanging environment if new mutations arise that are superior to any pre-existing variations

Douglas Futuyma
One of the most frightening things in the Western world, and in this country in particular, is the number of people who believe in things that are scientifically false. If someone tells me that the earth is less than 10,000 years old, in my opinion he should see a psychiatrist.

Francis Crick
There will be no difficulty in computers being adapted to biology. There will be luddites. But they will be buried.

Sydney Brenner
An atheist before Darwin could have said, following Hume: 'I have no explanation for complex biological design. All I know is that God isn't a good explanation, so we must wait and hope that somebody comes up with a better one.' I can't help feeling that such a position, though logically sound, would have left one feeling pretty unsatisfied, and that although atheism might have been logically tenable before Darwin, Darwin made it possible to be an intellectually fulfilled atheist

Richard Dawkins
Another curious aspect of the theory of evolution is that everybody thinks he understand it. I mean philosophers, social scientists, and so on. While in fact very few people understand it, actually as it stands, even as it stood when Darwin expressed it, and even less as we now may be able to understand it in biology.

Jacques Monod
The false view of evolution as a process of global optimizing has been applied literally by engineers who, taken in by a mistaken metaphor, have attempted to find globally optimal solutions to design problems by writing programs that model evolution by natural selection.